A Novel Methodology for Applying Multivoxel MR Spectroscopy to Evaluate Convection-Enhanced Drug Delivery in Diffuse Intrinsic Pontine Gliomas

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2016 Mar 5

PMID 26939629

Citations 5

Authors

D I Guisado

R Singh

S Minkowitz

Z Zhou

S Haque

K K Peck

R J Young

A J Tsiouris

M M Souweidane

S B Thakur

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Diffuse intrinsic pontine gliomas are inoperable high-grade gliomas with a median survival of less than 1 year. Convection-enhanced delivery is a promising local drug-delivery technique that can bypass the BBB in diffuse intrinsic pontine glioma treatment. Evaluating tumor response is critical in the assessment of convection-enhanced delivery of treatment. We proposed to determine the potential of 3D multivoxel (1)H-MR spectroscopy to evaluate convection-enhanced delivery treatment effect in these tumors.

Materials And Methods: We prospectively analyzed 3D multivoxel (1)H-MR spectroscopy data for 6 patients with nonprogressive diffuse intrinsic pontine gliomas who received convection-enhanced delivery treatment of a therapeutic antibody (Phase I clinical trial NCT01502917). To compare changes in the metabolite ratios with time, we tracked the metabolite ratios Cho/Cr and Cho/NAA at several ROIs: normal white matter, tumor within the convection-enhanced delivery infusion site, tumor outside of the infused area, and the tumor average.

Results: There was a comparative decrease in both Cho/Cr and Cho/NAA metabolite ratios at the tumor convection-enhanced delivery site versus tumor outside the infused area. We used MR spectroscopy voxels with dominant white matter as a reference. The difference between changes in metabolite ratios became more prominent with increasing time after convection-enhanced delivery treatment.

Conclusions: The comparative change in metabolite ratios between the convection-enhanced delivery site and the tumor site outside the infused area suggests that multivoxel (1)H-MR spectroscopy, in combination with other imaging modalities, may provide a clinical tool to accurately evaluate local tumor response after convection-enhanced delivery treatment.

Citing Articles

Convection Enhanced Delivery of Topotecan for Gliomas: A Single-Center Experience.

Upadhyayula P, Spinazzi E, Argenziano M, Canoll P, Bruce J Pharmaceutics. 2021; 13(1).

PMID: 33396668 PMC: 7823846. DOI: 10.3390/pharmaceutics13010039.

Magnetic resonance spectroscopic imaging in gliomas: clinical diagnosis and radiotherapy planning.

Laino M, Young R, Beal K, Haque S, Mazaheri Y, Corrias G BJR Open. 2020; 2(1):20190026.

PMID: 33178960 PMC: 7594883. DOI: 10.1259/bjro.20190026.

Evaluating infusate parameters for direct drug delivery to the brainstem: a comparative study of convection-enhanced delivery versus osmotic pump delivery.

Rechberger J, Power E, Lu V, Zhang L, Sarkaria J, Daniels D Neurosurg Focus. 2020; 48(1):E2.

PMID: 31896090 PMC: 7371267. DOI: 10.3171/2019.10.FOCUS19703.

Convection-Enhanced Delivery in Malignant Gliomas: A Review of Toxicity and Efficacy.

Shi M, Sanche L J Oncol. 2019; 2019:9342796.

PMID: 31428153 PMC: 6679879. DOI: 10.1155/2019/9342796.

Local DNA Repair Inhibition for Sustained Radiosensitization of High-Grade Gliomas.

King A, Corso C, Chen E, Song E, Bongiorni P, Chen Z Mol Cancer Ther. 2017; 16(8):1456-1469.

PMID: 28566437 PMC: 5545124. DOI: 10.1158/1535-7163.MCT-16-0788.

References

Tzika A, Astrakas L, Zarifi M, Zurakowski D, Poussaint T, Goumnerova L . Spectroscopic and perfusion magnetic resonance imaging predictors of progression in pediatric brain tumors. Cancer. 2004; 100(6):1246-56. DOI: 10.1002/cncr.20096. View

Helton K, Phillips N, Khan R, Boop F, Sanford R, Zou P . Diffusion tensor imaging of tract involvement in children with pontine tumors. AJNR Am J Neuroradiol. 2006; 27(4):786-93. PMC: 8133969. View

Bobo R, Laske D, Akbasak A, Morrison P, Dedrick R, Oldfield E . Convection-enhanced delivery of macromolecules in the brain. Proc Natl Acad Sci U S A. 1994; 91(6):2076-80. PMC: 43312. DOI: 10.1073/pnas.91.6.2076. View

Warren K . Diffuse intrinsic pontine glioma: poised for progress. Front Oncol. 2013; 2:205. PMC: 3531714. DOI: 10.3389/fonc.2012.00205. View

Yang I, Huh N, Smith Z, Han S, Parsa A . Distinguishing glioma recurrence from treatment effect after radiochemotherapy and immunotherapy. Neurosurg Clin N Am. 2009; 21(1):181-6. DOI: 10.1016/j.nec.2009.08.003. View

Meisamy S, Bolan P, Baker E, Bliss R, Gulbahce E, Everson L . Neoadjuvant chemotherapy of locally advanced breast cancer: predicting response with in vivo (1)H MR spectroscopy--a pilot study at 4 T. Radiology. 2004; 233(2):424-31. DOI: 10.1148/radiol.2332031285. View

Kinoshita Y, Yokota A . Absolute concentrations of metabolites in human brain tumors using in vitro proton magnetic resonance spectroscopy. NMR Biomed. 1997; 10(1):2-12. DOI: 10.1002/(sici)1099-1492(199701)10:1<2::aid-nbm442>3.0.co;2-n. View

Glunde K, Bhujwalla Z . Metabolic tumor imaging using magnetic resonance spectroscopy. Semin Oncol. 2011; 38(1):26-41. PMC: 3275885. DOI: 10.1053/j.seminoncol.2010.11.001. View

Laprie A, Pirzkall A, Haas-Kogan D, Cha S, Banerjee A, Le T . Longitudinal multivoxel MR spectroscopy study of pediatric diffuse brainstem gliomas treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2005; 62(1):20-31. DOI: 10.1016/j.ijrobp.2004.09.027. View

10.

Hipp S, Steffen-Smith E, Hammoud D, Shih J, Bent R, Warren K . Predicting outcome of children with diffuse intrinsic pontine gliomas using multiparametric imaging. Neuro Oncol. 2011; 13(8):904-9. PMC: 3145474. DOI: 10.1093/neuonc/nor076. View

11.

Howe F, Barton S, Cudlip S, Stubbs M, Saunders D, Murphy M . Metabolic profiles of human brain tumors using quantitative in vivo 1H magnetic resonance spectroscopy. Magn Reson Med. 2003; 49(2):223-32. DOI: 10.1002/mrm.10367. View

12.

Sandberg D, Edgar M, Souweidane M . Convection-enhanced delivery into the rat brainstem. J Neurosurg. 2002; 96(5):885-91. DOI: 10.3171/jns.2002.96.5.0885. View

13.

Gujar S, Maheshwari S, Bjorkman-Burtscher I, Sundgren P . Magnetic resonance spectroscopy. J Neuroophthalmol. 2005; 25(3):217-26. DOI: 10.1097/01.wno.0000177307.21081.81. View

14.

Soares D, Law M . Magnetic resonance spectroscopy of the brain: review of metabolites and clinical applications. Clin Radiol. 2008; 64(1):12-21. DOI: 10.1016/j.crad.2008.07.002. View

15.

Steffen-Smith E, Venzon D, Bent R, Hipp S, Warren K . Single- and multivoxel proton spectroscopy in pediatric patients with diffuse intrinsic pontine glioma. Int J Radiat Oncol Biol Phys. 2012; 84(3):774-9. PMC: 3386374. DOI: 10.1016/j.ijrobp.2012.01.032. View

16.

Laprie A, Catalaa I, Cassol E, McKnight T, Berchery D, Marre D . Proton magnetic resonance spectroscopic imaging in newly diagnosed glioblastoma: predictive value for the site of postradiotherapy relapse in a prospective longitudinal study. Int J Radiat Oncol Biol Phys. 2008; 70(3):773-81. DOI: 10.1016/j.ijrobp.2007.10.039. View

17.

Jain R . The next frontier of molecular medicine: delivery of therapeutics. Nat Med. 1998; 4(6):655-7. DOI: 10.1038/nm0698-655. View

18.

Chen H, Panigrahy A, Dhall G, Finlay J, Nelson Jr M, Bluml S . Apparent diffusion and fractional anisotropy of diffuse intrinsic brain stem gliomas. AJNR Am J Neuroradiol. 2010; 31(10):1879-85. PMC: 7964005. DOI: 10.3174/ajnr.A2179. View

19.

Hargrave D, Chuang N, Bouffet E . Conventional MRI cannot predict survival in childhood diffuse intrinsic pontine glioma. J Neurooncol. 2007; 86(3):313-9. DOI: 10.1007/s11060-007-9473-5. View

20.

Jansen M, van Vuurden D, Vandertop W, Kaspers G . Diffuse intrinsic pontine gliomas: a systematic update on clinical trials and biology. Cancer Treat Rev. 2011; 38(1):27-35. DOI: 10.1016/j.ctrv.2011.06.007. View